Nasal reconstruction in the 21st century--a contemporary review

Nasal restoration in the 21st century has reached a new milestone that has brought together centuries of experiences, lessons, errors, and rewards. The bar has been set and it is nothing less than a restoration of normal function and complete social acceptance. The aesthetic expectations of both minor and major nasal repair include symmetry, natural contour, excellent color and texture match, and a final product that remains inconspicuous to the casual observer. The major tenets that have been realized today include the wide application of the subunit principle, liberal and nonanatomic cartilage grafting (for form and function), and addressing each of the three layers of the nose independently. Anticipating resultant scars and vectors of tension during wound healing are the subtle nuances of nasal reconstruction that ensure a pleasing result. The robust nature of the forehead flap has proven to be a workhorse for major nasal resurfacing.